Pleural Mesothelioma Treatment
Pleural mesothelioma originates in the lining of the lungs (pleura). It’s the most common form of mesothelioma, and there are many treatment options available for it.
Surgeries for Pleural Mesothelioma
Surgery is most often considered for patients diagnosed in the early stages of pleural mesothelioma. Here, the cancer is still easily removable and hasn’t spread to distant areas of the body.
In later stages, surgery may be considered too risky — especially if patients are older or have other health problems besides mesothelioma.
Patients that qualify for surgery typically undergo an extrapleural pneumonectomy (EPP) or a pleurectomy with decortication (P/D).
Extrapleural Pneumonectomy (EPP)
An extrapleural pneumonectomy removes as much cancerous tissue from the chest cavity as possible. Surgeons remove the affected lung, the lining of the lungs, the lining of the heart, and parts of the diaphragm.
Cancer patients must be in good general health to qualify for this surgery as it is very aggressive. Patients may also face quality of life issues afterwards (like shortness of breath or dependence on an oxygen tank).
Pleurectomy With Decortication (P/D)
A pleurectomy with decortication removes cancerous tissue from the lining of the heart, lining of the lung, and diaphragm. The lung is left intact and is not removed.
A patient’s age does not affect their ability to receive a P/D. Many oncologists (cancer doctors) prefer it to an EPP even for younger patients since it offers many of the same benefits without the risks to quality of life.
Chemotherapy for Pleural Mesothelioma
Chemotherapy is one of the most common types of treatment for pleural mesothelioma patients. Most times, age and health do not limit who can receive chemotherapy. Pleural mesothelioma patients who undergo chemotherapy are usually given a combination of cisplatin and pemetrexed.
Chemotherapy drugs may be given alone as a palliative treatment to reduce painful symptoms, or as part of a multimodal plan to increase lifespan.
20+ years helping mesothelioma victims
“Chemotherapy is, for most people, intravenous. It goes in the vein. It goes through your whole system, [and] it kills your good cells and kills your bad cells.”
Learn more about top treatment options with a free veterans packet.
Hyperthermic Intrathoracic Chemotherapy (HITOC)
One type of chemotherapy used by doctors to treat pleural mesothelioma is called hyperthermic intrathoracic chemotherapy (HITOC). Doctors first remove all visible cancer tumors during surgery and then insert heated chemotherapy drugs into the surgery site.
HITOC allows doctors to destroy any microscopic cancer tumors that were not removed through surgery. A similar treatment is used in cases of peritoneal mesothelioma.
Radiation for Pleural Mesothelioma
Radiation may also be used alongside other treatments to help improve patient lifespan as an adjuvant (secondary) therapy. For example, it can kill cancer cells or tumors left behind after a surgery. However, it’s not used in high doses as the side effects can be toxic.
External Beam Radiation Therapy (EBRT)
Through EBRT, doctors use a machine to radiate tumors inside the body without the use of invasive surgery. According to the American Cancer Society (ACS), this is the most common type of radiation therapy used to treat mesothelioma and other cancers.
Doctors can use imaging methods such as computed tomography (CT) scans to map out the tumor, so just enough radiation is given. This is important as the radiation must pass through healthy tissues to reach the tumor through this process.
When brachytherapy is used, a capsule containing a radioactive material like iridium will be inserted directly into a patient’s body (usually through a catheter). The radiation can then break down the cancerous tumors.
The ACS notes that brachytherapy is not typically used as a mainstream mesothelioma treatment, but it may be available through trial programs.
Peritoneal Mesothelioma Treatment
Peritoneal mesothelioma originates in the lining of the abdomen (peritoneum). This type of mesothelioma accounts for 30% of all cases, making it the second most common form. These mesothelioma treatments aim to remove cancer from the peritoneum and other nearby organs.
Surgeries for Peritoneal Mesothelioma
Surgery may be used if the patient has been diagnosed early and they are in good health. Surgery removes as much cancerous tissue as possible to slow tumor growth and encourage remission.
Cytoreductive surgery is the most notable surgery for peritoneal mesothelioma. Through this surgery, doctors are able to remove visible cancerous tumors from the abdominal cavity. They’ll also remove the diseased peritoneum (abdominal lining).
Once cytoreductive surgery has been completed, doctors often then treat the surgery site with heated chemotherapy.
Peritoneal Mesothelioma Chemotherapy
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a commonly used cancer treatment for peritoneal mesothelioma. Doctors heat the chemotherapy drugs and apply them directly to the surgery site.
Treatment of Rare Mesothelioma Types
Rare types of mesothelioma — including pericardial (which forms in the lining of the heart) and testicular mesothelioma — require unique treatments to help patients live longer. These mesothelioma treatments typically involve removing cancerous tumors via surgery.
Pericardiectomy & Pericardiocentesis
A pericardiectomy is a surgical option for patients with pericardial mesothelioma. This procedure surgically removes some or all of the heart lining (pericardium) and as much of the cancer as possible.
The heart itself is not removed during this process, and removing the pericardium can improve heart function. Pericardial mesothelioma inflames the heart lining, which can cause the heart to work harder than it needs to.
When pericardial mesothelioma is often diagnosed in its later stages, patients may undergo a pericardiocentesis instead. This mesothelioma treatment removes excess fluid from the heart lining using a catheter.
Testicular mesothelioma is often treated with an orchidectomy. This surgery removes one or both of the testicles to prevent the cancer from spreading.
A partial orchiectomy may be performed in cases where only certain parts of the testicle need to be removed.
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Additional Mesothelioma Treatment Options
More mesothelioma treatments are now becoming available thanks to clinical trials and other research breakthroughs. Many of these new therapies can treat mesothelioma in ways the standard treatment options cannot.
Some experimental treatments have even gone on to become widely accepted means of treating mesothelioma, such as immunotherapy.
Immunotherapy uses medications to stimulate the body’s immune system so it can fight cancer cells more effectively. Immunotherapy medications can increase the immune system response in several ways.
Some drugs, such as Yervoy® (generic name ipilimumab), enhance the body’s ability to make T-cells, which the body generates to fight diseases like cancer. Others, like Opdivo® (generic name nivolumab), help the body’s T-cells target cancer cells more effectively.
In October 2020, the Food and Drug Administration (FDA) approved a combination of Opdivo and Yervoy for pleural mesothelioma patients. This marked the first mesothelioma treatment given clearance by the FDA in nearly 20 years.
“’I’m on immunotherapy right now and go to Chicago for treatment, and I have it IVed into me every other Wednesday since the middle of November. The side effects aren’t as bad as the clinical trial chemo I received a year ago in January.”
Dennis, Mesothelioma Patient
Photodynamic therapy for mesothelioma uses wavelengths from light to kill cancer cells. Patients first receive a light-sensitive medicine and are then exposed to a light source that destroys the cancer.
Photodynamic therapy may also be combined with other mesothelioma treatment options like a pleurectomy with decortication.
For example, doctors at Roswell Park Comprehensive Cancer Center can give patients light-sensitive medication before performing a P/D. After removing all visible cancer tumors and the lung lining, the surgery site is bathed in light to kill microscopic cancer cells.
Targeted therapy allows doctors to specifically pinpoint how mesothelioma cells are different from healthy cells, according to the ACS. For example, mesothelioma cells have certain genes and proteins that noncancerous cells do not.
Targeted therapy then destroys these genes and/or proteins, preventing the cancer cells from spreading.
Clinical Trials & Mesothelioma Treatments
Clinical trials are a great way to access new treatments for mesothelioma that aren’t widely available to the public yet. These cancer research programs test new treatments to see how effective they are.
For example, a study conducted by the University of Texas MD Anderson Cancer Center saw encouraging results when atezolizumab (an immunotherapy drug) and bevacizumab (a targeted chemotherapy) were combined to treat peritoneal mesothelioma.
85% of patients survived a year after starting the treatment and the cancer didn’t progress in 65% of cases. Tumors also decreased in 40% of patients.
Patients who are interested in participating in a clinical trial should speak to their cancer care teams. Please note that clinical trials are selective — patients may or may not be able to join depending on the criteria of the study.
Director of Medical Relations
“I encourage clinical trials because they’re free, so you don’t pay for anything. But you’ve got to be a really good candidate, because if you’re very sick, it’s a long process. And sometimes you’re getting placebo, and sometimes you’re getting the actual drug.”
Learn more about clinical trials with a free veterans packet.
Palliative Mesothelioma Treatments
Not every mesothelioma patient will qualify for life-extending treatments. That said, there are palliative mesothelioma treatments still available to help patients manage their symptoms and reduce their pain.
Palliative mesothelioma treatment options may be used to remove a portion of the tumor or to decrease fluid build-up, both of which may cause chest pain and discomfort.
Learn about common palliative care options below.
Patients with pleural mesothelioma often experience pleural effusions, which are buildups of fluid within the lung lining. While doctors can drain the effusions to improve breathing at a hospital, they may come back.
These patients may benefit from a PleurX catheter. The catheter is inserted into the chest wall and the patient is given a bottle to drain the fluid. The PleurX catheter allows patients to drain the fluid at home on their own schedule, without the need to go to the doctor.
The PleurX catheter can also be inserted into the abdomen to treat ascites, a buildup of fluid often found in peritoneal mesothelioma.
A pleurodesis is another way to manage recurrent pleural effusions. Through a pleurodesis, doctors first drain the pleura of any fluid that has built up. They then insert a chemical into the pleura to cause irritation, which essentially seals it shut. This means fluid can no longer build up in the pleural space.
Commonly used chemicals to perform a pleurodesis include talc, silver nitrate, and medications like doxycycline or cisplatin.
Paracentesis & Thoracentesis
Paracentesis and thoracentesis are mesothelioma treatments that remove excess fluid from the lining of the lung or abdomen, respectively. This helps to reduce abdominal bloating, improve lung function and breathing, and ease painful symptoms.
Doctors can perform a paracentesis or thoracentesis by inserting a thin needle into the site where the fluid has built up and drain it. A paracentesis or thoracentesis may also be used to collect a biopsy (sample of possibly cancerous fluid/tissue) during the diagnostic process.
While many mesothelioma surgeries aim to remove all of the cancer, other surgeries are used to ease symptoms. According to the ACS, these surgeries are typically used if the cancer has spread beyond the lymph nodes and into other major organs, as it is unresectable (meaning cannot be fully removed) at that point in time.
For example, debulking surgeries can remove some of the cancerous tumors to ease symptoms, but are not considered life-extending.
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Alternative Mesothelioma Treatments
There also may be alternative treatments available for patients with mesothelioma. Although these methods may help in relieving symptoms or stress, they are not a substitute for professional medical care.
Alternative treatments for mesothelioma include:
- Herbal therapies
- Meditation and breathing techniques
- Well-balanced diet
These lifestyle changes are often effective in increasing quality of life. They work to reduce stress and bolster general well-being. Patients also report many positive mental and physical health benefits.
How to Access Treatment for Mesothelioma Cancer
Determining where and how to access mesothelioma treatment can be difficult, as this cancer is rare and hard to diagnose. A mesothelioma doctor at a specialized cancer center can help patients get properly diagnosed and treated.
“It’s the most important thing in the world to go to the best doctor in the world for what you have.”
Dennis, Mesothelioma Patient
Veterans facing a mesothelioma diagnosis should know that the VA works with some of the top mesothelioma specialists in the country. These doctors dedicate their time and experience to helping veterans from all over the United States.
Based in Massachusetts, Dr. Lebenthal is a renowned pleural mesothelioma specialist (and veteran of the Israeli army) with extensive experience treating veterans.
Dr. Taylor Ripley is the director of the mesothelioma treatment center at Baylor St. Luke’s Medical Center in Houston. Dr. Ripley was trained by the late Dr. David Sugarbaker, one of the world’s top mesothelioma specialists.
A top thoracic surgeon in California, Dr. Cameron provides veterans who have pleural mesothelioma with the most effective treatments.
Visit the UCLA Health website to learn more about Dr. Robert Cameron.
The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.
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Mesothelioma Treatment Centers
There are also VA treatment centers around the country that specialize in mesothelioma. These mesothelioma cancer centers have access to cutting-edge treatment options and state-of-the-art equipment.
VA mesothelioma centers include:
VA Boston Healthcare System
The doctors at the VA Boston Healthcare System have treated veterans from over 15 states, and usually perform 300 mesothelioma surgeries per year. Its doctors are also affiliated with world-renowned mesothelioma treatment hospitals like Brigham and Women’s Hospital.
West Los Angeles VA Medical Center
Doctors at the West Los Angeles VA Medical Center have been treating mesothelioma since 1998, thanks to a partnership with the UCLA Comprehensive Mesothelioma Program. This facility specializes in the P/D to treat pleural mesothelioma.
Michael E. DeBakey VA Medical Center
Located in Houston, this VA medical center treats mesothelioma patients through its Cardiothoracic Surgery Program. Several of its mesothelioma doctors are affiliated with Baylor College of Medicine.
Many VA medical centers also provide free, temporary housing for veterans and their loved ones while mesothelioma treatment is occurring.
Affording Mesothelioma Treatment
VA mesothelioma treatment centers can work with a patient’s insurance company to ensure all medical claims and costs are taken care of. This reduces the stress of dealing with medical costs directly.
Patients without medical insurance still have options, though. Veterans and civilians with mesothelioma may be eligible for financial compensation to help pay for their medical care.
Financial support programs can be accessed through the VA and other avenues, including asbestos trust funds and settlements.
Request a free mesothelioma veterans packet to learn more about your compensation options.
Mesothelioma Treatment: Common Questions
Is mesothelioma always fatal?
No. While there is not yet a cure for mesothelioma, there have been cases of patients who have entered remission and survived well past their projected life expectancy.
Mesothelioma progresses differently in every patient. While average mesothelioma survival rates are statistically fairly low, aggressive treatment and a healthy lifestyle can help extend a patient’s lifespan.
Are there any new treatments for mesothelioma?
Yes. New and emerging treatments for mesothelioma are being tested and researched all the time.
The best way to access new mesothelioma treatment options is through clinical trials. Clinical trials study new treatments to help patients live longer and to provide relief to those who haven’t had success with traditional ones.
What is mesothelioma life expectancy without treatment?
The life expectancy of a mesothelioma patient without treatment is around 4-12 months. This is because mesothelioma is aggressive and can spread to distant areas of the body at a rapid rate.
How can veterans access mesothelioma treatments?
Veterans may be able to get mesothelioma treatments if they have VA Health Care. The VA Health Care program allows veterans to receive free or low-cost treatments from VA doctors. Veterans can join this health care program when they apply for VA benefits if they’re not automatically enrolled.
Outside of VA Health Care, veterans can also use private health care insurance plans to get mesothelioma treatments from civilian doctors.